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CHICAGO -- Obamacare may have expanded Medicaid coverage for millions of patients, but there's no clear picture that it's markedly improved access and quality of care. That's in part because inadequate physician payment in many states has kept many practice doors closed to this population, or entailed long waits for appointments.
Those are among many conclusions of a presented Sunday at an American Medical Association reference committee hearing. Recommendations from that hearing will be presented to the AMA House of Delegates, which will decide if the council's recommendations will become AMA policy.
"Quality of care is actually a bit of a controversial issue," said , of California, chair of the AMA Council on Medical Service.
With the Congressional Budget Office saying the expansion will cost the federal government $64 billion this year and $134 billion in 2026, "we certainly need to get that sorted out if we're going to spend this much money. We should be doing it in the most efficient way that benefits our patients the most," Hertzka said.
While access was better in states that have adopted Medicaid expansion programs, "obtaining health insurance (through Medicaid expansion) does not necessarily ensure better access to health care," the report said.
The report cited low payment for doctors in many states as a key factor in keeping the expansion's true impact below its potential. "I think most of us in most states don't see Medicaid as one of our better payers, and certainly Californians would attest to the fact that it's a pretty bad deal," Hertzka said.
"Despite some gains, ensuring access to health care remains an enduring challenge for Medicaid programs regardless of a state's decision to expand Medicaid," the report said.
And for those Medicaid plan offerings, half of all providers "were either not participating in the heath plan at the location listed by the health plan or not accepting new patients enrolled in the plan" More than one in four providers had wait times of more than 4 weeks.
Among the report's 15 recommendations, was one asking the AMA to press the Centers for Medicare & Medicaid Services to "provide strict oversight" to make sure states set physician payment rates "at levels to ensure there is sufficient participation." Another recommendation was for the AMA to "continue to advocate that CMS develop a mechanism for physicians to challenge payment rates directly to CMS."
The council report also suggested that state medical societies should take a proactive role in the development of Medicaid access monitoring in order to remove barriers.
, of the Iowa Medical Society applauded the council report but said more work was needed to define what is "adequate access," specifically for Medicaid plan networks.
"I would just like to bring up the point: Has anyone defined good access? Because unless we can actually measure it, it's going to be difficult to say whether a network has adequate access or is improving that," he said.
One doctor took issue with several of the recommendations. , of Oklahoma said it was unclear and seemed contradictory that the AMA would ask CMS to monitor physician pay rates. "What does that mean? We're going from today's rates to plus 1%, 2% or 5%? That seems contradictory to us supporting adequate payment and enhancing physician payment."
And he also questioned the idea that the AMA could enable physicians to successfully challenge their Medicaid rates at the federal agency level.
"How many times have we ever challenged payment rates at CMS and walked away as winners?" Gregory asked.